Magnetic Resonance Spectroscopic Analysis of Multifidus Muscle Lipid Contents and Association with Nociceptive Pain in Chronic Low Back Pain

Study design: Cross-sectional study. Background: Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity. Objectives: To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP). Methods: Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated. Results: During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA ( P = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively ( P < .001). Conclusions: Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.

Download Full-text

Vitamin D Deficiency Is Associated with Muscle Atrophy and Reduced Mitochondrial Function in Patients with Chronic Low Back Pain

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/6835341 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Katarzyna Patrycja Dzik ◽

Wojciech Skrobot ◽

Katarzyna Barbara Kaczor ◽

Damian Jozef Flis ◽

Mateusz Jakub Karnia ◽

...

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Protein Content ◽

Vitamin D Deficiency ◽

Muscle Atrophy ◽

Mitochondrial Function ◽

Chronic Low Back Pain ◽

Low Back ◽

Multifidus Muscle

Recent studies show that vitamin D deficiency may be responsible for muscle atrophy. The purpose of this study was to investigate markers of muscle atrophy, signalling proteins, and mitochondrial capacity in patients with chronic low back pain with a focus on gender and serum vitamin D level. The study involved patients with chronic low back pain (LBP) qualified for posterior lumbar interbody fusion (PLIF). Patients were divided into three groups: supplemented (SUPL) with vitamin D (3200 IU/day for 5 weeks), placebo with normal levels of vitamin D (SUF), and the placebo group with vitamin D deficiency (DEF). The marker of muscle atrophy including atrogin-1 and protein content for IGF-1, Akt, FOXO3a, PGC-1α, and citrate synthase (CS) activity were determined in collected multifidus muscle. In the paraspinal muscle, IGF-1 levels were higher in the SUF group as compared to both the SUPL and DEF groups (p<0.05). In the SUPL group, we found significantly increased protein content for pAkt (p<0.05) and decreased level of FOXO3a (p<0.05). Atrogin-1 content was significantly different between men and women (p<0.05). The protein content of PGC-1α was significantly higher in the SUF group as compared to the DEF group (p<0.05). CS activity in the paraspinal muscle was higher in the SUPL group than in the DEF group (p<0.05). Our results suggest that vitamin D deficiency is associated with elevated oxidative stress, muscle atrophy, and reduced mitochondrial function in the multifidus muscle. Therefore, vitamin D-deficient LBP patients might have reduced possibilities on early and effective rehabilitation after PLIF surgery.

Download Full-text